1. Holly Doherty Program Specialist October 25, 2016
Home and Community-Based Service- Adult Mental Health (HCBS-AMH) Referral and Enrollment Liaison
Holly Doherty
Program Specialist
October 25, 2016

2. What is HCBS-AMH?
Home and Community Based Services-Adult Mental (HCBS-AMH) is a program that is provided through a 1915(i) State Plan Amendment (SPA).
It is designed to provide home and community-based services (HCBS) to adults with extended tenure in mental health facilities, frequent arrests or emergency department visits.
It was formally approved by the Centers for Medicare and Medicaid Services (CMS) on October 13, 2015, for individuals with extended tenure in mental health facilities .

3. Program Goals Provide HCBS for adults with mental health needs
Improve quality of life for program participants
Improve functioning
Support long-term recovery in the community

4. Expansion
The HCBS-AMH program was expanded by H.B.1, 84th Legislature, Regular Session, 2015 (Article II, Department of State Health Services [DSHS], Rider 61.b) to:
Divert populations with serious mental health illness (SMI) from jails and
Emergency departments into community treatment programs.

5. Expansion Continued
The Health and Human Services Commission (HHSC) has proposed an amendment to the HCBS-AMH SPA to include adults with SMI and:
Frequent arrests (Jail Diversion)
Frequent emergency department visits (Emergency Department Diversion [EDD])
Pending CMS approval of the Jail Diversion and EDD criteria, HCBS provided to these populations are funded via General Revenue. General Revenue-funded services may be limited due to budgetary restraints

6. Eligibility Criteria HCBS-AMH Target Populations:
Long-term Psychiatric Hospitalization (LTPH)
State hospitals will be referring LTPH population only
Jail Diversion
EDD
Eligibility is based on the criteria as defined in the HCBS-AMH Provider Manual:
See Section Initial Criteria

7. LTPH Eligibility Criteria
Must be 18 years of age or older with a diagnosis of SMI;
Medicaid eligible
Limited amount of General Revenue funds available for individual’s who meet financial eligibility for Medicaid but cannot otherwise obtain Medicaid
Financial eligibility (150 percent of the Federal Poverty Limit or below)
During the past five years prior to their referral
Reside three or more (cumulative or consecutive) years in an inpatient psychiatric hospital (1095 days)

8. Eligibility Criteria HCBS-AMH defines SMI as:
An illness, disease, disorder, or condition (other than a sole diagnosis of dementia, substance use disorder, or intellectual or developmental disability) that:
Substantially impairs an individual’s thought, perception of reality, emotional process, development, or judgment or
Grossly impairs an individual’s behavior as demonstrated by recent disturbed behavior

9. Service Array
The HCBS-AMH program provides an array of services, appropriate to each individual’s needs, to enable these individuals to live and experience successful tenure in their community.
A full description of services can be found at:
Services are:
Provided in individual’s chosen community
Support through the program is offered for the lifetime of the individual, if clinically indicated.

10. HCBS-AMH Medicaid Services
Host Home/Companion Care
Supported Home Living
Supervised Living Services
Assisted Living
HCBS-AMH Psychosocial Rehabilitation Services
Employment Services:
Supported Employment
Employment Assistance
Minor Home Modification
Home-delivered Meals
Transition Assistance
Adaptive Aids
Transportation Services (non-duplicative of state plan medical transportation)
Community Psychiatric Supports and Treatment
Peer Support
Respite Care (short term)
Substance Use Disorder Services
Nursing
Recovery Management

11. HCBS-AMH Settings
HCBS-AMH services are provided in “home and community-based settings, including:
Individual homes
Apartments
Assisted living facilities
Small community-based residences
HCBS-AMH settings do not include the following:
A nursing facility
An institution for mental diseases
An intermediate care facility (ICF) for individuals with intellectual disabilities
A hospital providing long-term care services
Any other location that have qualities of an institutional setting

12. HCBS-AMH Settings
In accordance with Code of Federal regulations § Home and Community-Based Settings qualifications include:
The setting is integrated in and supports full access to the greater community.
The setting is selected by the individual and documented in the Individual Recovery Plan (IRP) and is based on the individual’s needs, preferences, and resources available for room and board.
Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint
Optimizes autonomy and independence in making life choices
Facilitates choice regarding services and who provides them
Code of Federal Regulations § : bin/textidx?SID=0d6b4b979e777ae9ee1a8502dc64111c&mc=true&node=se _1710&rgn=div8

13. Referral and Enrollment
An individual is not eligible for enrollment if participating in any other HCBS program:
Community Living Assistance and Support Services
Deaf Blind with Multiple Disabilities
Home and Community-based Services Waiver
Texas Home Living Waiver
STAR+PLUS HCBS Waiver
Individuals deemed eligible for HCBS-AMH may choose to dis-enroll from their current HCBS program and enroll in HCBS-AMH.

14. Referral Process
State Hospital staff have access to the Initial Criteria Report (ICR), sent by HHSC HCBS-AMH staff monthly, and/or gather supporting documentation and confirm the individual meets the initial eligibility criteria, including financial eligibility.

15. Referral Process Continued
State Hospital staff work with the individual and/or guardian to complete the referral and enrollment packet, which consists of the following:
HCBS-AMH Consent for Eligibility Determination and Enrollment Form
HCBS-AMH Uniform Assessment (UA), which encompasses the Adult Needs & Strengths Assessment
Notification of Participation Rights
HCBS-AMH Provider Selection Form
State Hospital staff provide the following to the individual as part of the enrollment packet:
DSHS Handbook of Consumer Rights, Mental Health Services
HCBS-AMH Participant Handbook
These documents are located at:

16. Referral Process Continued
State Hospital staff submits the completed Referral and Enrollment packet via secure to with the subject line titled “Referral”.
HCBS-AMH staff place the individual on the Inquiry List and review eligibility (within five business days).
Reviews include the ICR Report or supporting documentation, UA and TIERS for Financial Eligibility.

17. Eligibility Determination
Forensic Commitment eligibility:
If the individual is on a forensic commitment or in the custody of the criminal justice system they are placed in Pending Status for up to 60 days.
This allows time for State Hospital staff to advocate for hospital discharge with the involved parties, making enrollment in HCBS-AMH possible.

18. Enrollment
Once an individual is enrolled into the HCBS-AMH program HCBS-AMH staff notifies the referring SH staff, individual, and the selected HCBS-AMH Service Provider and Recovery Manager (RM).
Notification to the RM includes Point of Contact (POC) at the identified SH for coordination of care.

19. Planning and Delivery of Care for Individuals Referred from State Hospital
After notification of selection by HCBS-AMH participant the RM:
Contacts the State Hospital POC and works collaboratively to schedule a fingerprinting or background check appointment if this process has not already been completed
State Hospital procedure requires services providers pass SH background check prior to meeting with the individual
The RM schedules initial Individual Recovery Plan (IRP) meeting with individual in the SH.
The RM has 14 days from the enrollment notification from HCBS-AMH staff that they have been selected to meet with the individual and complete the Initial IRP.

20. Planning and Delivery of Care for Individuals Referred from State Hospital Continued
The RM:
Provides transitional services to the individual for three to six months
Assists individual with coordinating services they will need in the community. RM submits an updated IRP to reflect these additional services

21. Social Security Administration (SSA) Pre-release Agreement
SH staff follow the DSHS Policies and Procedures:
State Hospital Guidelines and Procedures: OP 5-7 SSA Pre-release Agreement

22. SSA Pre-release Agreement Continued
Purpose:
Identify and formalize procedures to facilitate timely processing of Social Security Income (SSI) applications
Benefits:
Application can be initiated 90 days prior to discharge from the SH as opposed to 30 days
Medical decision can be used for up to one year
60 day timeframe that an appeal can be submitted

23. Referral and Enrollment Contact
Holly Doherty, LBSW, MBA
Program Specialist
Home and Community Based Services-Adult Mental Health
Mental Health Substance Abuse Division
(512)

24. Additional Contact Information
Website: Program

25. HCBS-AMH Team Provider Liaison: Lauv Bruner, M.S. (512) 838-4356
Expansion Liaison:
Shelley Smith, LPC
(512)
Recovery Management Liaison:
Robert Johnson , LPC
(512)
Quality Management Liaison:
Tabitha Anastasi
(512)

26. Questions?
Speaker’s name Speaker’s title Phone number address